慢性肝病患者肠外肠内营养支持与膳食干预专家共识

北京医学会肠外肠内营养学专业委员会， 《慢性肝病患者肠外肠内营养支持与膳食干预专家共识》专家委员会

doi:10.3969/j.issn.1001-5256.2017.07.006

慢性肝病患者肠外肠内营养支持与膳食干预专家共识

DOI: 10.3969/j.issn.1001-5256.2017.07.006

北京医学会肠外肠内营养学专业委员会，《慢性肝病患者肠外肠内营养支持与膳食干预专家共识》专家委员会

详细信息

中图分类号: R459.3;R575
计量
- 文章访问数: 4023
- HTML全文浏览量: 43
- PDF下载量: 1113
- 被引次数: 0
出版历程
- 收稿日期: 2017-04-20
- 出版日期: 2017-07-20

Consensus on the clinical nutritional intervention for patients with chronic liver diseases

Beijing Medical Association,Committee of Parenteral and Enteral Nutrition;Expert Panel on Consensus on the parenteral and Enteral Nutritional and the Dietary Intervention for Patients with Chronic Liver Diseases

摘要

摘要:
肝脏是人体最重要的代谢器官。肝脏疾病时可出现复杂的营养素代谢改变和不同程度的营养不良(不足),而营养状态又反过来影响肝病的发生、发展和预后,形成恶性循环。营养支持(肠外营养支持、肠内营养支持、膳食干预)在慢性肝病患者(代偿期/失代偿期肝硬化、慢加急/亚急性肝衰竭、慢性肝衰竭)的治疗中起重要作用。但此领域缺少大样本、高质量的临床研究报告,且国内尚无有关临床诊疗的共识。从"合理应用营养支持疗法,改善慢性肝病患者临床结局"出发,本共识专家组系统总结相关文献,并结合我国慢性肝病的临床实践,完成此共识,以期为慢性肝病的临床诊疗提供参考。
- 慢性肝病 /
- 营养支持 /
- 专家共识
Abstract:
Liver is the most important metabolic organ in the human body.The varying nutrient metabolism and malnutrition (undernutrition) occur in people with chronic liver diseases.Malnutrition and chronic liver damage are reciprocal causation, leading to form a vicious spiral.Whether nutritional support for patients with chronic liver disease (compensated or decompensated cirrhosis, acute on chronic liver failure and chronic liver failure) can play a role in improving the outcome is the focus of our attention.In recent years, there is still lack of large sample, high quality clinical reports in this field.Based on systematic review of major literatures and clinical practice of chronic liver disease in our country, this consensus would provide references for physicians, nurses, dietitians and pharmacists in clinical work related to chronic liver disease.
- chronic liver diseases /
- nutritional intervention /
- expert consensus

HTML全文

参考文献(75)

[1]PATEK AJ, POST J.Treatment of cirrhosis of the liver by a nutritious diet and supplements rich in vitamin B complex[J].J Clin Invest, 1941, 20 (5) :481-505.

[2]SASIDHARAN M, NISTALA S, NARENDHRAN RT, et al.Nutritional status and prognosis in cirrhotic patients[J].Trop Gastroenterol, 2012, 33 (4) :257-264.

[3]VULCANO DS, CARVALHAES MA, BAKONYI NETO A.Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation[J].Acta Cir Bras, 2013, 28 (10) :733-739.

[4]MERLI M, GIUSTO M, GENTILI F, et al.Nutritional status:its influence on the outcome of patients undergoing liver transplantation[J].Liver Int, 2010, 30 (2) :208-214.

[5] JIANG ZM, ZAN SY, JIA XW, et al.Basic methods and procedures for the development/revision of Clinical diagnosis and treatment guidelines[J].Natl Med J China, 2016, 96 (4) :250-253. (in Chinese) 蒋朱明, 詹思延, 贾晓巍, 等.制定/修订《临床诊疗指南》的基本方法及程序[J].中华医学杂志, 2016, 96 (4) :250-253.

[6]CAREGARO L, ALBERINO F, AMODIO P, et al.Malnutrition in alcoholic and virus-related cirrhosis[J].Am J Clin Nutr, 1996, 63 (4) :602-609.

[7]CAMPILLO B, RICHARDET JP, SCHERMAN E, et al.Evaluation of nutritional practice in hospitalized cirrhotic patients:results of a prospective study[J].Nutrition, 2003, 19 (6) :515-521.

[8]O'BRIEN A, WILLIAMS R.Nutrition in end-stage liver disease:principles and practice[J].Gastroenterology, 2008, 134 (6) :1729-1740.

[9]KERWIN AJ, NUSSBAUM MS.Adjuvant nutrition management of patients with liver failure, including transplant[J].Surg Clin North Am, 2011, 91 (3) :565-578.

[10]MENG QH, WANG JH, YU HW, et al.Resting energy expenditure and substrate metabolism in chinese patients with acute or chronic hepatitis B or liver cirrhosis[J].Inter Med, 2010, 49 (19) :2085-2091.

[11]Mc CLAVE SA, MARTINDALE RG, VANEK VW, et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) [J].JPEN J Parenter Enteral Nutr, 2009, 33 (3) :277-316.

[12]PERIYALWAR P, DASARATHY S.Malnutrition in cirrhosis:contribution and consequences of sarcopenia on metabolic and clinical responses[J].Clin Liver Dis, 2012, 16 (1) :95-131.

[13]PENG S, PLANK LD, Mc CALL JL, et al.Body composition, muscle function, and energy expenditure in patients with liver cirrhosis:a comprehensive study[J].Am J Clin Nutr, 2007, 85 (5) :1257-1266.

[14]CARVALHO L, PARISE ER.Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis[J].Arq Gastroenterol, 2006, 43 (4) :269-274.

[15]MENG QH, YU HW, LI J, et al.Inadequate nutritional intake and protein-energy malnutrition involved in acute and chronic viral hepatitis Chinese patients especially in cirrhosis patients[J].Hepatogastroenterology, 2010, 57 (101) :845-851.

[16]MENG QH, HOU W, YU HW, et al.Resting energy expenditure and substrate metabolism in patients with acute-on-chronic hepatitis B liver failure[J].J Clin Gastroenterol, 2011, 45 (5) :456-461.

[17]WANG JH, LI J, FENG YM, et al.Energy metabolism and clinical features of patients with sub-acute-on-chronic alcoholic liver failure[J].Beijing Med J, 2011, 33 (12) :970-973. (in Chinese) 王金环, 李娟, 冯岩梅, 等.酒精性肝衰竭患者能量代谢与临床特点[J].北京医学, 2011, 33 (12) :970-973.

[18]WANG JH, LI J, YU HW, et al.Energy metabolism and clinical features in patients with alcoholic cirrhosis[J].Parenter Enteral Nutr, 2014, 21 (4) :201-204. (in Chinese) 王金环, 李娟, 于红卫, 等.酒精性肝硬化病人能量代谢和临床特点[J].肠外与肠内营养, 2014, 21 (4) :201-204.

[19]ALBERINO F, GATTA A, AMODIO P, et al.Nutrition and survival in patients with liver cirrhosis[J].Nutrition, 2001, 17 (6) :445-450.

[20]TSIAOUSI ET, HATZITOLIOS AI, TRYGONIS SK, et al.Malnutrition in endstage liver disease:recommendations and nutritional support[J].J Gastroenterol Hepatol, 2008, 23 (4) :527-533.

[21]MUELLER C, COMPHER C, ELLEN DM, et al.ASPEN clinical guidelines:nutrition screening, assessment, and intervention in adults[J].JPEN J Parenter Enteral Nutr, 2011, 35 (1) :16-24.

[22] ZHANG Y, JIANG ZM.Nutrition screening, assessment, and intervention are key steps for nutritional diagnosis and treatment in adults:the American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines in 2011[J].Chin J Clin Nutr, 2012, 20 (5) :261-268. (in Chinese) 张颐, 蒋朱明.营养筛查、评定与干预是成人营养诊疗的关键步骤:美国肠外肠内营养学会 (ASPEN) 2011年临床指南[J].中华临床营养杂志, 2012, 20 (5) :261-268.

[23]Mc CLAVE SA, TAYLOR BE, MARTINDALE RG, et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) [J].JPEN J Parenter Enteral Nutr, 2016, 40 (2) :159-211.

[24]KYLE UG, KOSSOVSKY MP, KARSEGARD VL, et al.Comparison of tools for nutritional assessment and screening at hospital admission:a population study[J].Clin Nutr, 2006, 25 (3) :409-417.

[25]STRATTON RJ, KING CL, STROUD MA, et al.'Malnutrition U-niversal Screening Tool'predicts mortality and length of hospital stay in acutely ill elderly[J].Br J Nutr, 2006, 95 (2) :325-330.

[26]SCHIESSER M, MLLER S, KIRCHHOFF P, et al.Assessment of a novel screening score for nutritional risk in predicting complication in gastro-intestinal surgery[J].Clin Nutr, 2008, 27 (4) :565-570.

[27]AMARAL TF, ANTUNES A, CABRAL S, et al.An evaluation of three nutritional screening tools in a Portuguese oncology centre[J].J Hum Nutr Diet, 2008, 21 (6) :575-583.

[28]OZKALKANLI MY, OZKALKANLI DT, KATIRCIOGLU K, et al.Comparison of tools for nutrition assessment and screening for predicting the development of complications in orthopedic surgery[J].Nutr Clin Pract, 2009, 24 (2) :274-280.

[29]PUTWATANA P, REODECHA P, SIRAPO-NGAM Y, et al.Nutrition screening tools and the prediction of postoperative infectious and wound complications:comparison of methods in presence of risk adjustment[J].Nutrition, 2005, 21 (6) :691-697.

[30]HENDERSON S, MOORE N, LEE E, et al.Do the malnutrition universal screening tool (MUST) and Birmingham nutrition risk (BNR) score predict mortality in older hospitalised patients?[J].BMC Geriatr, 2008, 8:26.

[31]ATALAY BG, YAGMUR C, NURSAL TZ, et al.Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support[J].JPEN J Parenter Enteral Nutr, 2008, 32 (4) :454-459.

[32]ODELLI C, BURGESS D, BATEMAN L, et al.Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer[J].Clin Oncol (R Coll Radiol) , 2006, 17 (8) :639-645.

[33]PERSSON M, HYTTER-LANDAHL A, BRISMAR K, et al.Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition[J].Clin Nutr, 2007, 26 (2) :216-224.

[34]BABINEAU J, VILLALON L, LAPORTE M, et al.Outcomes of screening and nutritional intervention among older adults in healthcare facilities[J].Can J Diet Pract Res, 2008, 69 (2) :89-94.

[35]NORMAN K, KIRCHNER H, FREUDENREICH M, et al.Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with nonneoplastic gastrointestinal disease-a randomized controlled trial[J].Clin Nutr, 2008, 27 (1) :48-56.

[36]JIANG ZM, CHEN W, ZHU SN, et al.An investigation of incidence rates of malnutrition and nutritional risk and application of nutritional support in grade A tertiary hospitals in large cities in Eastern, Middle, and Western China[J].Chin J Clin Nutr, 2008, 16 (6) :335-337. (in Chinese) 蒋朱明, 陈伟, 朱赛楠, 等.我国东、中、西部大城市三甲医院营养不良 (不足) 、营养风险发生率及营养支持应用状况调查[J].中国临床营养杂志, 2008, 16 (6) :335-337.

[37]WILSON JMG, JUNGNER G.Principles and practice of screening for disease (Public health paper No 34) [M].Geneva:World Health Organization, 1968.

[38]JENS K, REMY M.Screening by NRS 2002 improves clinical outcome[J].Chin J Clin Nutr, 2013, 21 (3) :133-139. (in Chinese) 詹斯·康卓普, 雷米·梅耶.营养风险筛查NRS 2002改善临床结局[J].中华临床营养杂志, 2013, 21 (3) :133-139.

[39]TANIGUCHI E, KAWAGUCHI T, ITOU M, et al.Subjective global as sessment is not sufficient to screen patients with defective hepatic metabolism[J].Nutrition, 2011, 27 (3) :282-286.

[40]GUNSAR F, RIAMONDO ML, JONES S, et al.Nutritional status and prognosis in cirrhotic patients[J].Aliment Pharmacol Ther, 2006, 24 (4) :563-572.

[41]YU HW, HOU W, SHI SY, et al.Comparison of different nutritional assessments and a try of a new method in nutritional assessment for liver disease[J].Parenter Enteral Nutr, 2016, 23 (2) :82-86. (in Chinese) 于红卫, 侯维, 时淑云, 等.不同营养评价方法在肝病病人中的比较及适宜肝病营养评价的方法[J].肠外与肠内营养, 2016, 23 (2) :82-86.

[42]MOCTEZUMA-VELZQUEZ C, GARCA-JUREZ I, SOTO-SOLS R, et al.Nutritional assessment and treatment of patients with liver cirrhosis[J].Nutrition, 2013, 29 (11-12) :1279-1285.

[43]AMODIO P, BEMEUR C, BUTTERWORTH R, et al.The nutritional management of hepatic encephalopathy in patients with cirrhosis:International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus[J].Hepatology, 2013, 58 (1) :325-336.

[44]ALVARES-DA-SILVA MR, REVERBEL DA SILVEIRA T.Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients[J].Nutrition, 2005, 21 (2) :113-117.

[45]MONTANO-LOZA AJ, MEZA-JUNCO J, PRADO CM, et al.Muscle wasting is associated with mortality in patients with cirrhosis[J].Clin Gastroenterol Hepatol, 2012, 10 (2) :166-173.

[46]HOLT EW, FREDERICK RT, VERHILLE MS.Prognostic value of muscle wasting in cirrhotic patients[J].Clin Gastroenterol Hepatol, 2012, 10 (9) :1056.

[47]CEDERHOLM T, BARAZZONI R, AUSTIN P, et al.ESPENguidelines on definitions and terminology of clinical nutrition[J].Clin Nutr, 2017, 36 (1) :49-64.

[48]MANGUSO F, D'AMBRA G, MENCHISE A, et al.Effects of an appropriate oral diet on the nutritional status of patients with HCV-related liver cirrhosis:a prospective study[J].Clin Nutr, 2005, 24 (5) :751-759.

[49]CUNHA L, HAPPI NONO M, GUIBERT AL, et al.Effects of prolonged oral nutritional support in malnourished cirrhotic patients:results of a pilot study[J].Gastroenterol Clin Biol, 2004, 28 (1) :36-39.

[50]NEY M, VANDERMEER B, van ZANTEN SJ, et al.Meta-analysis:oral or enteral nutrition supplementation in cirrhosis[J].Aliment Pharmacol Ther, 2013, 37 (7) :672-679.

[51]KORETZ RL.The evidence for the use of nutritional support in liver disease[J].Curr Opin Gastroenterol, 2014, 30 (2) :208-214.

[52]ANTAR R, WONG P, GHALI P.A meta-analysis of nutritional supplementation for management of hospitalized alcoholic hepatitis[J].Can J Gastroenterol, 2012, 26 (7) :463-467.

[53]PLAUTH M, CABRE, RIGGIO O, et al.ESPEN guidelines on enteral nutrition:liver disease[J].Clin Nutr, 2006, 25 (2) :285-294.

[54]MOUZAKI M, NG V, KAMATH BM, et al.Enteral energy and macronutrients in end-stage liver disease[J].JPEN J Parenter Enteral Nutr, 2014, 38 (6) :673-681.

[55]NIELSEN K, KONDRUP J, MARTINSEN L, et al.Long-term oral refeeding of patients with cirrhosis of the liver[J].Br J Nutr, 1995, 74 (4) :557-567.

[56]BUNOUT D, AICARDI V, HIRSCH S, et al.Nutritional support in hospitalized patients with alcoholic liver disease[J].Eur J Clin Nutr, 1989, 43 (9) :615-621.

[57]PLAUTH M, CABRE, CAMPILLO B, et al.ESPEN guidelines on parenteral nutrition:hepatology[J].Clin Nutr, 2009, 28 (4) :436-444.

[58]VILSTRUP H, AMODIO P, BAJAJ J, et al.Hepatic encephalopathy in chronic liver disease:2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J].Hepatology, 2014, 60 (2) :715-735.

[59]NAKAYA Y, OKITA K, SUZUKI K, et al.BCAA-enriched snack improves nutritional state of cirrhosis[J].Nutrition, 2007, 23 (2) :113-120.

[60]MUTO Y, SATO S, WATANABE A, et al.Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis[J].Clin Gastroenterol Hepatol, 2005, 3 (7) :705-713.

[61]MARCHESINI G, BIANCHI G, MERLI M, et al.Nutritional supplementation with branched-chain amino acids in advanced cirrhosis:a double-blind, randomized trial[J].Gastroenterology, 2003, 124 (7) :1792-1801.

[62]Chinese Society of Parenteral and Enteral Nutrition, Chinese Medical Association.Beijing Society for Parenteral and Enteral Nutrition.Expert consensus on clinical application of vitamin preparations[J].Chin J Surg, 2015, 53 (7) :481-487. (in Chinese) 中华医学会肠外肠内营养学分会, 北京医学会肠外肠内营养学分会.维生素制剂临床应用专家共识[J].中华外科杂志, 2015, 53 (7) :481-487.

[63]LI XM, HOU W, HUANG PL, et al.The deficiency and supplementation of vitamin B1 in patients with acute on chronic liver failure[J].Parenter Enteral Nutr, 2013, 20 (2) :72-74. (in Chinese) 李雪梅, 侯维, 黄沛力, 等.慢加急性肝功能衰竭病人维生素B1的缺乏与补充[J].肠外与肠内营养, 2013, 20 (2) :72-74.

[64]ZHAO J, LI J, YU HW, et al.Dietary intake of selenium and serum selenium in patients with chronic hepatitis B, liver cirrhosis and acute-on-chronic liver failure[J].J Clin Hepatol, 2015, 31 (7) :1103-1106. (in Chinese) 赵娟, 李娟, 于红卫, 等.慢性乙型肝炎、肝硬化与慢加急性肝衰竭患者饮食摄入硒及血清硒水平的对比分析[J].临床肝胆病杂志, 2015, 31 (7) :1103-1106.

[65]MARCHESINI G, FABBRI A, BIANCHI G, et al.Zinc supplementation and amino acid-nitrogen metabolism in patients with advanced cirrhosis[J].Hepatology, 1996, 23 (5) :1084-1092.

[66]Mc CLAIN C, MARSANO L, BURK RF, et al.Trace metals in liver disease[J].Semin Liver Dis, 1991, 11 (4) :321-39.

[67]FERREIRA LG, FERREIRA MARTINS AI, CUNHA CE, et al.Negative energy balance secondary to inadequate dietary intake of patients on the waiting list for liver transplantation[J].Nutrition, 2013, 29 (10) :1252-1258.

[68]BEMEUR C, BUTTERWORTH RF.Nutrition in the management of cirrhosis and its neurological complications[J].J Clin Exp Hepatol, 2014, 4 (2) :141-150.

[69]BUTTERWORTH RF.Parkinsonism in cirrhosis:pathogenesis and current therapeutic options[J].Metab Brain Dis, 2013, 28 (2) :261-267.

[70] Liver Failure and Artificial Liver Group, Chinese Severe Liver Diseases and Artificial Liver Group.Diagnostic and treatment guidelines for liver failure (2012 version) [J].Chin J Hepatol, 2013, 21 (3) :177-183. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华肝脏病杂志, 2013, 21 (3) :177-183.

[71]CABRE E, RODRIGUEZ-IGLESIAS P, CABALLERIA J, et al.Short-and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition:a multicenter randomized trial[J].Hepatol, 2000, 32 (1) :36-42.

[72]YU HW, ZHAO J, WANG KF, et al.Effects of late evening snack on energy metabolism in cirrhotic patients with different ChildPugh grades[J].Infect Dis Info, 2012, 25 (4) :216-219. (in Chinese) 于红卫, 赵娟, 王克菲, 等.睡前加餐对不同Child-Pugh分级肝硬化患者能量代谢的影响研究[J].传染病信息, 2012, 25 (4) :216-219.

[73]HOU W, LI J, LU J, et al.Effect of a carbohydrate-containing late-evening snack on energy metabolism and fasting substrate utilization in adults with acute-on-chronic liver failure due to Hepatitis B[J].Eur J Clin Nutr, 2013, 67 (12) :1251-1256.

[74]PLANK L, GANE E, PENG S, et al.Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis:a randomized 12-month trial[J].Hepatology, 2008, 48 (2) :557-566.

[75]FUKUSHIMA H, MIWA Y, IDA E, et al.Nocturnal branched-chain amino acid administration improves protein metabolism in patients with liver cirrhosis:comparison with daytime administration[J].JPEN JParenter Enteral Nutr, 2003, 27 (5) :315-322.

施引文献

资源附件(0)

访问统计